Benoit Molly, Chiles Kelly, Hsieh Michael
Thomas Jefferson University (MB), Philadelphia, Pennsylvania, and Department of Urology, George Washington University (KC) and Division of Urology, Children's National Medical Center (MH), Washington, D.C.
Urol Pract. 2018 May 1;5(3):198-204. doi: 10.1016/j.urpr.2017.03.007. Epub 2017 Mar 27.
The Patient Protection and Affordable Care Act(ACA) significantly increased the number of Americans with health insurance and has greatly improved access to health care services. However, states retain considerable jurisdiction over what benefits must be offered. The lack of a federal mandate for fertility preservation coverage results in a patchwork of benefits dependent on state statutes and regulation. Pediatric, adolescent and unmarried patients diagnosed with cancer or autoimmune diseases that impact fertility are often carved out of such coverage.
This review analyzed legislative and regulatory efforts in 10 states to determine the breadth of fertility preservation coverage in private, employer-based insurance plans and Medicaid, with particular interest in coverage for pediatric and adolescent patients.
Fifteen states require coverage of fertility preservation in private insurance plans; five states only extend this benefit to females. The statutes differ in terms of whom the coverage extends to based on marriage status, diagnosis, length of fertility problems, and the monetary limit of the benefit. Fertility preservation is not a mandatory benefit under federal Medicaid regulation, however states can opt to include it in their state Medicaid plan; no state currently covers fertility preservation as an optional benefit.
Coverage of fertility preservation is extremely limited both in scope of benefits and the number of states that require such a benefit. State governments can expand access to a fertility preservation benefit by removing spousal and expanding diagnostic criteria and by including the benefit in Medicaid plans.
《患者保护与平价医疗法案》（ACA）显著增加了拥有医疗保险的美国人数量，并极大地改善了医疗服务的可及性。然而，各州在必须提供哪些福利方面仍保留相当大的管辖权。由于缺乏联邦对生育力保存保险范围的强制规定，导致福利情况参差不齐，这取决于州法规和监管。被诊断患有影响生育力的癌症或自身免疫性疾病的儿科、青少年及未婚患者往往被排除在这类保险范围之外。
本综述分析了10个州的立法和监管举措，以确定私人雇主医保计划和医疗补助计划中生育力保存保险范围的广度，尤其关注儿科和青少年患者的保险范围。
15个州要求私人保险计划涵盖生育力保存；5个州仅将此福利扩展至女性。这些法规在保险范围基于婚姻状况、诊断、生育问题时长以及福利金额限制所涵盖的对象方面存在差异。根据联邦医疗补助法规，生育力保存并非强制性福利，不过各州可选择将其纳入本州的医疗补助计划；目前没有州将生育力保存作为一项可选福利涵盖在内。
生育力保存的保险范围在福利范围和要求提供此类福利的州数量方面都极为有限。州政府可以通过取消配偶相关限制、扩大诊断标准以及将该福利纳入医疗补助计划来扩大生育力保存福利的可及性。
